Smoke and Mirrors
by WaltzMatildah
Summary: Alex  'suprise suprise'  Oneshot: Written for LJ Altered Mind States challenge so there's no puppies and kittens that's for sure. Some implied AlexIzzie but mostly just pure unadulterated angst! Loosely connected to the start of the second season.


_**'I was much further out than you thought;**_

_**And not waving but drowning.'**_

_**Stevie Smith**_

_**xxx**_

**Smoke and Mirrors**

_**He is fifteen million two hundred and forty six thousand seven hundred and twenty minutes old…**_

"Izzie, wait…just…"

"…Shit..." he stumbles, physically, emotionally and verbally.

A trifecta of ineptitude.

"…Izzie, I just want…"

"Yeah, well you know what Alex? I don't want to hear it, just forget we even bothered…" Izzie spins, all fury and flashing blue eyes that would stop him dead.

If he hadn't stopped years ago.

"…in fact, I've forgotten already…" an insincere smirk makes his skin crawl and her last word fades out as she walks away.

"I failed the boards…" he whispers to her retreating back, nowhere near loud enough for her to hear which is okay because he doesn't think he really wants her to anyway, doesn't think she wants to hear it either.

"But it doesn't matter…" he finishes, just as quietly, even though it does. It's the only thing that matters and the only thing he can think about and he has spent the whole day fighting to stay one step ahead of the panic that he can feel chasing at his heels. He can't stop and he can't slow down because if it catches him he knows he'll lose it and do something he'll really regret.

Or maybe not.

He can't stop his hands from shaking and he's had to keep them stuffed under his armpits or deep in his pockets to conceal the evidence and he's lost count of how many times he's vomited. He was supposed to scrub in on two surgeries today but managed to find plausible excuses to do something else.

Anything else.

Nothing else.

Nothing at all.

There is one flight of stairs and about seventeen strides between him and the front doors of the hospital and even though his shift finished over an hour ago he can't bring himself to leave because he's scared he will never come back if he does.

He could fore-go the stairs, short cut the journey…cheat…by taking the elevator but the thought of letting the doors close behind him sucks the air out of his lungs and greys his vision.

He misses the moment that he goes from alone to accompanied and might have flinched when the person now seated beside him spoke…if he was listening.

"…Alex?"

He blinks slowly and turns his head to the left before realising the sound had originated from the right.

"…Hmmm?"

"Are you okay?"

He laughs because there isn't really anything else to say.

He chose arrogant and cocky years ago because nothing else seemed to work quite as effectively. He breathed it and lived it and believed it until he _became_ it and now he can't seem to turn it off. He hates the qualities in others but recognises how badly he needs them himself, knows instinctively how he would fall apart without them. The smirk that never makes it any further than his lips was a natural addition to his impressive repertoire.

He can be very convincing when he needs to be.

_**On the day he was born so were eleven thousand seven hundred and eighty five other people…**_

He doesn't know why he didn't kiss Izzie, he doesn't know why he panicked during the exam, he doesn't know why he froze to the point of not being able to function in the elevator with George, he doesn't know why he is here.

He does know he might love Izzie, he does know that the idea of being responsible for the lives of others terrifies him, he does know no body believes in him, least of all himself, he does know he shouldn't be here.

"Dr. Karev?"

He's more aware this time and even manages to paste a wide smile across his face, so cheesy and fake his cheeks almost crack, before turning to face his latest inquisitor.

"So..?"

"So…" he exhales slowly, the grin long since vanished, perhaps it was never there.

"You can re-sit…"

He nods his understanding.

"I know…"

"It's not the end of the world…"

"I know that too…"

His world had ended long before now.

As she leaves he stands up slowly, his lower legs are cold because he has been sitting so long that the blood flow has been restricted to them. He takes three tentative strides before his throat constricts and the desire to sit again becomes so strong he almost slumps directly to the floor.

A different voice, behind him, holds him up.

"Are you coming?"

_Sometimes he is coming, though mostly he is going._

"Coming where?"

"To Joe's…it's tequila o'clock…everyone else is already there…"

Code for _'Izzie is already there'_, he can pick it a mile away…a disguised warning.

"Oh…no I don't think so, I'm just gonna…"

She's looking at him, puzzled…almost comical. He realises it's because he's never let himself feel like this in public before and he probably looks different. Maybe there is a neon sign above his head, flashing.

"Are you okay?"

He switches the sign off.

As easy as that.

As difficult as it is.

"Of course I am, just not really up for tequila, or Cyclone Izzie for that matter, I'll just see you tomorrow…"

She nods and tilts her head to the side, contemplative.

"Okay, see you tomorrow."

He nods back in agreement because she expects him to, pauses almost to wait for it but he wonders if she really will.

He doubts it because tomorrow is only a day away and he's looking forward to tomorrow with an earnest yearning that sears the soles of his feet because it will mean that _today_ is over and everything will be back to normal, _he_ will be back to normal.

What is normal anyway?

Tomorrow never comes.

_**He has thirty three scars on the outside and just one on the inside…**_

He was told once that he would never amount to anything and he wonders what it would be like to confront that person today and flash his medical degree in their face.

But his limbs are heavy and he only makes it to the top of the stairs before he has to sit again so he thinks appearing in front of his father would be physically impossible. And besides, it's difficult to confront someone you've not spoken to for over ten years. Someone you don't know the whereabouts of. Someone who could be dead for all you know.

Which would be typical really, if he was.

So he plays it out in his head instead because usually it's easier that way.

Usually.

He falters on his father's name and has to quell the sudden rise of vomit in the back of his throat. He wonders when this happened because he doesn't remember feeling like this for months, he thought coming here must have cured it. He thought he had changed.

You can run but you can't hide.

His fingers itch to pull his sleeves up high enough to see the shallow white lines that, although healed, still deaden his arm with a numb heaviness, but even now he knows that this is neither the time nor the place. Is there ever a time or a place? He always had favoured hiding spots, secret refuges that only he knew about. A particular cubicle in the toilets at the school gymnasium, the one with Marie Watson's phone number etched into the back of the door and a message scrawled underneath to call her for a good time.

He'd called once, it wasn't that good.

There was a park half a block from his house, wild and overgrown. A rusted arch, once white, marked its entrance and if he was high enough when he walked through he could just about convince himself he was somewhere else. Anywhere his parents weren't was somewhere else.

He preferred knives to blades back then. Blades seemed so…contrived. So hollywood. Made it all mean so much less than it should have. He's not sure what he will use next time.

Faded skin, fresh memories.

Raw scars, not all of them physical.

But they all bled equally at the time.

Bleed equally now.

He wonders if Izzie would consider giving him a second chance but then he remembers he probably won't be around long enough to give a second chance too. He's not sure what will get him first, failed exams or failed life.

He's had plenty of practice at both.

He leans his forehead against the cool wall beside him and thinks about the pressure that would be required to put his skull through the plasterboard. He read an article once where a student flipped out during an exam and sharpened a pencil to an arrow sharp point before calmly shoving it up her nostril and into her brain.

Such stories fascinate him and he sometimes fantasises about carrying out similar scenarios himself but instinctively knows that when it comes down to it he is neither original enough nor brave enough.

So he settles for doing it in his dreams instead.

He closes his eyes and this time he is Melanie, an Australian girl who taped a Bunsen Burner tube to her nose and tried to gas herself to eternity in the school science lab. Brilliant. The thought alone makes him giddy with light-headed desire.

Soft-soled shoes move silently past him and down the stairs. He doesn't lift his head and at the point where the figure is directly beside him he can see no further up than a set of scrub clad knees. The world looks different from this height.

But is it really?

It's dirtier and he expects the sun probably shines less. There is more to get in the way but less to think about which is a pleasant change.

_**His heart pumps two million six hundred and eighty eight thousand litres of blood every year…**_

He knows he's becoming dangerously morbid. He recognises the signs, has both studied them and experienced them in varying degrees in the past. He was medicated once. Was found vomiting blood and unconscious on the bathroom floor of his dorm room and the cocktail they pumped from his stomach would have made even his father cringe. A night in emergency and a prescription for something meant to make it all better later and he ended up sleeping through an entire week of university before anyone realised he hadn't been to class.

He was woken late on the Friday afternoon and invited to an impromptu party as though nothing was different. That night, surrounded by dozens of festive party goers, he had never felt more alone.

He flushed the medication down the toilet one by one the very next day, popped each pill from its foil casing and flushed once, repeated the action eighteen times and vowed to be more careful in the future.

He half stands again and slumps his way down a few more stairs before lethargy and apathy and terror catch up with him and push him to the ground again. The weight on his shoulders is immense, it's making his back ache so much that he suddenly wants to lie straight. If the weight settles on his chest maybe it will crush his lungs.

His breathing is starting to shallow out and the extra inhalations he needs to keep him oxygenated are also making his heart race and his temperature rise until he is so Goddamn hot he shrugs out of his coat and lets the cold seep through his sweat sticky shirt.

He recognises these signs too and vaguely thinks about fumbling for the inhaler in his pocket but the scars on his left arm have made it too heavy to lift and his right is pinned beneath him slightly and slowly going numb.

Like the rest of him already is.

Has been for years.

_**He is only one in six point six billion…**_

Asthma attacks used to terrify him to the point of paranoia. He would keep himself awake all night to make sure he didn't suffocate in his sleep. He never was quite sure what scared him more, the actual dying part or the fact that he would be alone when it happened.

Like he is now.

More recently though they have come to fascinate him. The feel of not being able to breathe is very intense and it is in these moments, where he is close to death, that he feels most alive.

He slides down another step, or maybe it's two…three, he's not quite sure and forgets to count the bone jarring bumps under his backside as they travel up his spine, vertebrae by vertebrae.

Bruising.

His lungs are heaving now and while he can't hear himself, the world has gone strangely still and silent, he can see his broad chest over expanding and fighting the confines of his tight t-shirt, distorting the brand name emblazoned across its front.

He knows that it's late, that there is only a skeleton staff still at the hospital, that it is unlikely anyone will happen upon him and come to his rescue. If he decides he's not ready yet then he needs to rescue himself.

It's decision time.

In the past this is the point where he has chickened out. Shoved his fingers deep down the back of his throat or sliced across instead of down. He's set himself a precedent and he wonders if he is strong enough to stick to it or if this time will be the last time. It's all happening so quickly and he's not left with any time to think, to consider, to weigh up his options.

To figure out if he even has any options in the first place.

In a way it's probably better like this, out of his hands. Quick. Like pulling off a bandaid.

Like pulling the trigger.

"Alex?"

There are voices around him, or maybe it's only one voice. He can't be sure who or how or where.

"Alex, are you down…"

It's above him and is being drowned out by the slap of shoes on the metal tips of the stairs as someone descends with haste.

His palms are slippery with sweat and the angle at which he is now slumped is making it difficult to access the depths of his pocket but he tries valiantly anyhow, for show more than anything else.

His mouth moves to form a word but speaking is beyond him by this point and it's a redundant reaction anyway, he has nothing left to say. The decision has been taken out of his hands.

This time.

He starts to cough and panics when he can't stop.

Ready or not, here it comes.

_**Two thousand one hundred and sixty one people die every day…**_

A thousand hours pass by…or maybe just a heartbeat.

Hands are suddenly all over him and he is shocked momentarily to find that he had forgotten he was no longer alone. He's not sure if there are faces too because all he can feel are hands on his back and on his face, cupping his cheek, concerned. He can not remember ever being touched like this before.

He refuses to open his eyes in case it's all a dream.

A high pitched screaming pierces his resolve and his eyelids flutter open, there are black spots marring his vision but he can see enough to identify the blonde hair of his rescuer. He thinks it is him screaming because the sound matches the feel of his blood travelling through his veins but when he sees her throat constrict he knows it's not him.

Suddenly there are people everywhere and they are not as gentle as she was and he thinks he preferred it when they were alone. He wants to tell them to go away but they outnumber him and they are much stronger than he is.

In so many ways.

They slip their hands under his arms and behind his knees and haul him down those last few stairs, the ones he couldn't manage on his own, until he is lying flat on the ground at the bottom.

He is looking up at them now, like he has finally reached the sandy bed of the ocean and is staring up at them, their faces and their words distorted by endless kilometres of clear, cloudless water.

He settles in to watch the sun set through the shimmering liquid and wonders if this is what it is like to drown.

He is snapped back when scissors are produced and his t-shirt is cut away. There is nowhere to hide now. They will find what he has done, what he will probably do again.

His intricate artwork.

Something hard and plastic is jammed against his teeth and he raises his eyes as far as he can and looks at her face through the shadows of his own lashes. Her lips are moving, fast…too fast and he can't make out what she is saying.

The plastic between his teeth is shaken, violently, and he lowers his eyes again to see what it is. Izzie's hand is wrapped around the base of his inhaler. She has obviously retrieved it from his pocket and now the whites of her clenched knuckles are contrasting with the dull blue of the device.

He wonders if his lips are the same colour and wishes he could see them.

She grabs his right hand and pulls it towards her, wrapping it round her own. Indicating for him to tell her when to push. He obeys but only because she asks so nicely.

But his fingers only tighten slightly and she has to do all the work for him meaning the timing is off and he forgets to inhale but he doesn't think it will matter anyway.

It's almost too late for that.

She is crying and he is unsure what to make of it.

He tries to curl up on his side.

His back muscles are spasming and the pain is excruciating and reminds him that he is still alive. The hands from before are back and press him flat once again causing him to arch off the cold tiles in protest before he is suddenly floating through the air, weightless.

He flails and bucks and tries to sit up. One leg falls free and throws him off balance and he is suddenly moving face first towards the floor. He puts a hand out knowing it will do little to break his fall but he stops before he hits and is rolled onto a gurney that has obviously been lowered after one failed attempt to lift him up.

The gurney is moving now and the lights above his head flash in and out, disco style.

When it's bright she is there, when it's dark she is not.

He is no longer sure which outcome he will prefer.

A mask is pressed over his nose and mouth as they feed him a familiar mixture of oxygen and helium. Electrodes are slapped on his chest and an IV is hurriedly inserted to administer intravenous steroids.

They are refusing to give up and he makes the decision to go with them.

It seems kinda rude not to.

_**Twenty four thousand eight hundred and twenty three American men take their own lives every year…**_

When he can breathe again without it feeling like his sternum has shattered he attempts to push the mask aside with the wave of an uncoordinated fist. He is only half way to his face when his fingers are caught in someone else's and without opening his eyes he knows she is there.

He smiles, not realising it is lost in the mask and because it doesn't reach his eyes she doesn't know that he is happy she is there.

The familiar feeling of utter exhaustion that follows a severe attack is creeping up on him fast and he wants to say something before the moment is lost and it's too late. His back is still aching and he shifts slightly in an attempt to alleviate some of the pain.

A cool hand brushes his forehead.

Like being branded with ice.

He groans and is embarrassed when that is all he can manage.

"Shhh…go to sleep…" she whispers back and though his eyes are closed he can trace the outline of her face with his memory.

When he awakens he is unsure how much time has passed. He opens his eyes and is unexpectedly disappointed to find the room empty. His gaze lowers to the top of his left arm where three thin silvery lines remind him with crushing force who he is and what he has done.

Mercifully, a white sheet is covering the lines on his stomach and thighs.

The door swings open and she is four steps into the room before she realises he is awake.

"Alex…"

He nods, not trusting his voice.

"How do you feel?" she looks at him when she delivers the words but at the end of the sentence her eyes flick to the scars on his arm.

A silent full stop.

He wonders if they found the others.

He wonders what they thought.

"I'm okay…" he croaks, his throat feels like molten lead has stripped it bare and he is deeply uncomfortable and insecure under her piercing gaze.

"No you're not."

Not a question, a statement.

Like she knows and is just informing him of that fact.

"Your inhaler was in your pocket the whole time…" her voice is quiet and unsure and when her eyes move towards the scars again he wonders if she even knows she is doing it.

"Why didn't you use it?"

He doesn't know if she is expecting him to answer and can't think of a way to adequately describe the feelings he had whilst suffocating alone in the stairwell.

He knows she will never understand.

She can rescue him time and time again but nothing will change.

_**If he slit both wrists…deep…it would take him less than five minutes to bleed out…**_

The tension in the room is palpable and he is feeding off it.

Becoming it.

He takes a shuddering breath that almost splits him in two. He tries to turn his head to face her but the muscles in his neck and along the sides of his spine cramp, white hot agony. Air catches in his raw throat only this time he doesn't welcome it.

He just wants it over.

He whimpers pitifully and grinds his teeth together. The sound fills his head and fights the pain for prime position in his body, leaving the only empty space where his heart used to be.

Before he lost it.

Years ago.

She moves towards him, curious, concerned, apprehensive, unsure.

"What's wrong?"

He's not breathing because it's easier that way. The mask he had removed during his sleep is replaced and he doesn't have the energy to tell her that it's not the problem.

"Alex? Talk to me…"

"Back and…neck…" he wheezes breathily, so quiet she must lean in closer to hear "…cramp…"

"Oh…I'll get you…"

"No…no, it's okay, it's…"

If there's no pain he can't tell if he's still alive.

But she won't understand that.

He grins.

"It's okay now," he whispers, "…you can go."

Who knew there could be so many different shades of black?

**END**

A/N: Please don't take too much notice of the 'facts' between the paragraphs. While they are reasonably accurate (I believe), some of them I had to calculate myself so I can't guarantee the figures! Please don't go quoting me or basing empirical arguments off them! They are purely there for effect!

Hope you liked it!


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